ANALYSIS OF HEPATIC VEIN WAVE-FORM BY DOPPLER ULTRASONOGRAPHY IN 100 PATIENTS WITH PORTAL-HYPERTENSION

Objectives: We classified the Doppler waveform seen in patients with p ortal hypertension and examined the associations of the waveform type with the diagnosis of Budd-Chiari syndrome and severity of the liver c irrhosis. Methods: The Doppler pattern of right and left hepatic veins in 100 consecutive Japanese patients with portal hypertension and eso phagogastric varices was classified into six types: I, triphasic wavef orm; II, biphasic waveform without reversed flow; III, decreased ampli tude of phasic oscillations; IV, flat waveform with fluttering; V, com pletely net waveform with fluttering; VI, no waveform. All patients un derwent computed tomography and magnetic resonance imaging. Patients i n whom hepatic vein waveform showed type IV, type V, or type VI, posit ively underwent hepatic venography and inferior vena cavography. Resul ts: Type I was seen in 31 of 100 patients, type II in 35, type III in 17, type IV in eight, type V in four, and type VI in five. Types I-IV waveform indicated no lesion in hepatic veins and inferior vena cave, type V indicated stenosis of hepatic veins or occlusion of inferior ve na cava, and type VI, occlusion of hepatic veins. For one patient with type V hepatic veins, balloon angioplasty was done, and the waveform changed from type V to type II. Examining the relationship between hep atic vein waveform and the Child-Pugh score, liver function of type IV cases was worse than that of type I cases in 66 cirrhotic patients wi thout hepatocellular carcinoma(p < 0.05). There was no clear relations hip between hepatic vein waveform and portal venous perfusion, as base d on Nordlinger's grade. Conclusions: Our classification of hepatic ve in waveform in Doppler ultrasonography is useful in diagnosing Budd-Ch iari syndrome, in judging the efficiency of treatment for hepatic vein lesions, and in assessing severe liver function in cirrhotic patients .